Population Health Profile: 2013

Transcription

1 Population Health Profile: Suite 3, level 1, 336 Keira Street 1/154 Meroo Road Wollongong NSW 2500 Bomaderry NSW 2541 PO Box 1198 Wollongong NSW 2500 PO Box 516 Nowra NSW 2541 t f t f Medicare Locals gratefully acknowledge the financial and other support from the Australian Government Department of Health and Ageing Grand Pacific Health Ltd (ABN ), trading as Illawarra-Shoalhaven Medicare Local

2 The purpose of this Population Health Profile: 2013 is to accurately identify and quantify the local health needs of the resident population of the Illawarra-Shoalhaven Medicare Local (ISML) catchment. It aims to inform the development of focused and responsive primary care services by using a population approach into inter-agency service planning for disease prevention and early intervention initiatives, focusing on targeted population cohorts. This Population Health Profile: 2013 is an inaugural framework document that will be accompanied by supplementary releases containing regularly updated recent data and figures, as and when sourced and adapted from various reliable sources of information. The authors will attempt to keep the Population Health Profile and subsequent Population Health publications current and accurate with all the information required to inform effective and regionally appropriate primary healthcare planning for the Illawarra-Shoalhaven. Suggested Citation: Ghosh A, McDonald K and Marshall K. (2013), Illawarra-Shoalhaven Medicare Local - Population Health Profile: Grand Pacific Health Ltd. trading as Illawarra-Shoalhaven Medicare Local. Acknowledgement: The authors would like to acknowledge The Centre for Health Service Development at the University of Wollongong for their valuable inputs through their 2012 report: Thompson C, Eckstein G, McDonald K, Fildes D, Samsa P, Westera A, Cuthbert E and Eagar K. (2012) Health Profile & Needs Assessment Planning After hours Primary Care in the Illawarra-Shoalhaven Medicare Local. Centre for Health Service Development, University of Wollongong. Page 2

3 Table of Contents 1. GEOGRAPHY... 7 Table 1: Illawarra Shoalhaven Medicare Local (ISML) regional geography... 7 Figure 1: Map of Illawarra-Shoalhaven indicating all Statistical Local Areas (SLA) DEMOGRAPHY Existing population indicators... 8 Table 2: Estimated resident population, ISML regions, Figure 2: Map of total usual resident population, ISML regions, Table 3: Population age structure, ISML regions, Figure 3: Population age structure, ISML regions, percentages Population projections Table 4: Population projections, ISML regions, Table 5: Projected change in population, ISML regions, numbers Figure 4: Share of projected additional residents, ISML areas, Population diversity and target groups Culturally and linguistically diverse (CALD) communities Table 6: Non-English speaking background (NESB) population, ISML regions, Figure 5: Map of culturally and linguistically diverse population, ISML regions, 2011 percentages of total population Table 7: Poor proficiency at speaking English, ISML regions, Indigenous population Table 8: Indigenous population, ISML regions, Figure 6: Map of Indigenous population, ISML regions, 2011 percentage of total population Figure 7: Age distribution comparison of Indigenous and non-indigenous population, ISML catchment, Aged population Figure 8: Map of population aged 65 years and above, ISML regions, 2011 percentage of total population Table 9: Population aged 65 years and above, ISML regions, Table 10: Population projections for persons aged 65 years and above, ISML regions, Table 11: Population projections for persons aged 85 years and above, ISML regions, Single parent population Table 12: Single parent population, ISML regions, Page 3

4 Table 13: Single parent families with children aged below 15 years, ISML regions, Regional or remote populations Table 14: Population by remoteness categories, ISML, SOCIO-ECONOMY Table 15: Index of relative socio-economic disadvantage, ISML regions, Table 16: Unemployment rate and labour force participation, ISML regions, June Table 17: Jobless families and children under 15 years of age, ISML regions, Table 18: Very low income earners (less than $300 per week), ISML regions, Table 19: Low income households (less than $600 per week), ISML regions, Access Table 20: Private dwellings with no motor vehicle, ISML regions, Table 21: Private dwellings with no internet connection, ISML regions, Table 22: Centrelink income support recipients, ISML regions, Table 23: Private health insurance and health care card coverage, ISML regions Education Figure 9: Highest year of schooling completed, ISML catchment, Table 24: Youth participation in education, ISML regions, 2011 & Early childhood indicators Figure 10: Immunisation coverage* (%), ISML, latest financial quarters Table 25: Developmental vulnerability in school children by domains, ISML areas, Table 26: Developmental vulnerability in school children by no. of domains, ISML areas, Housing and social isolation Table 27: Homelessness^, ISML areas, Table 28: Social isolation in older ages, ISML regions, Table 29: Housing stress in lower income households^, ISML regions, HEALTH STATUS, DISEASE BURDEN AND EPIDEMIOLOGY Table 30: Births and total fertility rates, ISML regions, Table 31: Mortality and standardised death rates, ISML regions, Table 32: Avoidable deaths, ISML Areas, Table 33: Avoidable deaths and major causes, ISML regions, Table 34: Disability^ within the general and the aged population, ISML regions, Figure 11: Carer population proportions and disability prevalence, 2011, ISML regions35 Table 35: Estimated prevalence of major health risk factors, ISML, Page 4

5 Table 36 Estimated maternal and child health indicators, ISML, Table 37: Synthetic prevalence estimates of major risk factors and maternal and child health indicators, ISML regions, Table 38: Synthetic prevalence estimates of major chronic disease groups, ISML regions, Table 39: Synthetic prevalence estimates of specific chronic conditions, ISML regions, Table 40: Synthetic prevalence estimates of mental health conditions, ISML regions, Table 41: Mortality and disease burden of major cancers, ISML, Table 42: Participation in cancer screening, ISML, HEALTH SERVICES AND UTILISATION Primary Care Table 43: Service utilisation rates by category of GP services, Table 44: GP service utilisations, ISML regions, Table 45: Utilisation of selected items specific to primary care services, ISML regions, Table 46: Service utilisation rates by category of Allied Health services, Acute and sub-acute care Figure 12: Location of hospitals in the ISML catchment Hospitalisation rates Table 47: Hospitalisations by causes, ISML areas, latest available years Hospitalisation for ambulatory care sensitive conditions (ACSC) Table 48: Hospitalisations for ambulatory care sensitive conditions (ACSC), ISML areas, Emergency department (ED) admissions Figures 13 & 14: Triage 4 presentation trends and Triage 5 presentation trends, ISLHD Figure 15: Proportional ED Presentations by Hospitals, ISLHD, Aged care Figure 16: Proportions of persons aged 65 years and above who are: disabled and disabled residing in long term accommodation, ISML regions, Table 49: Aged Care Places, ISML Regions, Table 50: Population ratios of aged care places, ISML regions, Special programs and target groups Commonwealth Home and Community Care (HACC) program Table 51: Home & Community Care program: service instances, ISML regions, Page 5

6 Table 52: Home and Community Care program: client profile, ISML regions, Better Access program Table 53: Better Access program: service Utilisation, ISML regions, Key Indigenous health findings PRIMARY HEALTH WORKFORCE CAPACITY General practice Table 54: Summary of general practice workforce statistics, ISML, Figure 17 & 18: GP gender proportions and GP age proportions, ISML, Figure 19: Distribution of general practices, ISML regions, Figure 20: GP distribution*, ISML regions, Figure 21: Estimates of GP full-time equivalents (FTE) rates per 100,000 population^, ISML regions, Figure 22: Age distribution of general practitioners, ISML, Figure 23: Proportions of practices employing practice nurses, ISML regions, Allied health Figure 24: Proportions of allied health professionals*, ISML, CONCLUSION Demographic and socio-economic priority groups Heath priority themes Other priority themes KEY BIBLIOGRAPHY Page 6

7 1. GEOGRAPHY The Illawarra-Shoalhaven Medicare Local (ISML) covers a large geographic region that extends for square kilometres (sq km) from Helensburgh in the northern Illawarra to North Durras in the southern Shoalhaven 1. The Illawarra typically refers to the three Local Government Areas (LGAs) of Wollongong, Shellharbour and Kiama whilst the Shoalhaven consists entirely of the Shoalhaven LGA 2. The Commonwealth Territory of Jervis Bay also falls under the catchment area of the ISML. The Wollongong LGA and the Shoalhaven LGA are further divided into two Statistical Local Areas (SLAs) called Wollongong Inner and Wollongong-Balance and Shoalhaven-Pt A and Shoalhaven-Pt B respectively. For ease of understanding and convenience the ISML catchment will be described using the terminology listed in Table 1. A geographic representation of the Illawarra-Shoalhaven SLAs is shown in Figure 1. Table 1: Illawarra Shoalhaven Medicare Local (ISML) regional geography LOCAL GOVERNMENT AREA (LGA) STATISTICAL LOCAL AREA (SLA) HEALTH PROFILE TERMINOLOGY Areas Regions Commonwealth Territory Jervis Bay Territory JERVIS BAY JERVIS BAY Kiama (A) Kiama (A) KIAMA KIAMA Shellharbour (C) Shellharbour (C) SHELLHARBOUR SHELLHARBOUR Shoalhaven (C) Shoalhaven (C) - Pt A Shoalhaven (C) - Pt B Wollongong (C) Wollongong (C) - Inner Wollongong (C) Bal ILLAWARRA-SHOALHAVEN SHOALHAVEN NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG WOLLONGONG Inner WOLLONGONG Balance ISML Catchment Figure 1: Map of Illawarra-Shoalhaven indicating all Statistical Local Areas (SLA) Page 7

8 2. DEMOGRAPHY 2.1. Existing population indicators The 2011 estimated resident population of the ISML catchment is shown in Table 2. The Wollongong Inner and the Shellharbour regions are the most densely populated regions within the ISML catchment. Compared to the NSW state population density figure of nine persons/sq km, all ISML regions except Jervis Bay stand higher than the state average. The Shoalhaven Balance region clearly resembles rural population distributions with a density figure of only 14.3 persons/sq km. The Usual Resident Population counts have also been mapped in Figure 2. Table 2: Estimated resident population, ISML regions, 2011 REGIONS Estimated resident population (ERP) Population density (persons/sq km) JERVIS BAY KIAMA 20, SHELLHARBOUR 66, NOWRA-BOMADERRY 34, SHOALHAVEN Balance 61, WOLLONGONG Inner 104, WOLLONGONG Balance 96, Source: ABS 2012 ISML Catchment 384, Figure 2: Map of total usual resident population, ISML regions, 2011 Page 8

9 The age structure distribution of the population of the ISML catchment as shown in Table 3 and Figure 3 indicates an overall ageing population with 17.6% aged 65 years and above. The Shoalhaven Balance region has a significantly higher proportion of older aged population while Shellharbour and Jervis Bay regions have the highest proportion of school aged children. Table 3: Population age structure, ISML regions, 2011 REGIONS & over Total JERVIS BAY KIAMA 1,076 2,540 2,565 4,215 6,253 2,181 2,002 20,832 SHELLHARBOUR 4,453 9,415 9,120 16,912 16,840 5,276 4,038 66,054 NOWRA- BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance 2,327 4,536 4,788 8,172 8,787 3,049 2,785 34,444 3,082 6,924 5,953 11,106 18,454 8,815 7,265 61,599 6,136 11,280 16,753 28,642 25,164 8,183 8, ,601 6,358 12,760 12,661 24,348 24,762 8,333 7,392 96,614 ISML Catchment 23,456 47,529 51,917 93, ,309 35,849 31, ,531 Source: ABS 2012 Figure 3: Population age structure, ISML regions, percentages Source: ABS 2012 Page 9

10 Tourism is also a major factor in assessing population especially during the peak holiday periods Tourism NSW data indicates that the Shoalhaven and Wollongong areas received the largest number of tourist nights with 3,800,000 and 2,836,000 respectively. With the South Coast standing as the third most visited tourist area within NSW in 2011, the regions of Shoalhaven Balance and the Wollongong Inner were amongst the top three most visited regions of the South Coast. Additionally the Shoalhaven Balance area had the second highest number of tourist nights in NSW. Tourism NSW estimates that Shoalhaven receives 35% of its annual visitor nights or approximately 33,000 visitors per night during the period between Christmas and the end of January. This additional influx of tourist population adds to the health and welfare responsibilities of the regional primary and tertiary healthcare providers Population projections The total population of the Illawarra-Shoalhaven is projected to reach 421,830 in 2021 with the addition of 37,686 more residents. This equates to an average annual growth rate of 0.9% projected per annum. With a projected average annual growth rate of 1.9%, the region of Shoalhaven Balance is expected to have the highest growth in its population followed by the Wollongong Balance region with a 1.2% projected per annum growth from 2011 to 2021.The respective regional population projections for all age groups are shown in Table 4 and Table 5. Table 4: Population projections, ISML regions, 2021 REGIONS Total KIAMA 1,090 2,510 2,430 4,220 6,280 3,040 2,580 22,150 SHELLHARBOUR 4,600 9,390 8,880 18,380 18,060 7,310 5,660 72,280 NOWRA- BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance 2,220 4,460 4,230 8,690 9,340 4,740 4,030 37,710 3,480 7,940 5,810 12,560 21,640 12,810 9,730 73,970 6,170 11,710 15,000 28,360 26,200 10,410 9, ,310 6,970 13,380 12,380 26,950 26,750 11,300 10, ,410 ISML Catchment 24,530 49,390 48,730 99, ,270 49,610 42, ,830 Source: NSW Department of Planning, 2010 Page 10

11 Table 5: Projected change in population, ISML regions, numbers REGIONS Total KIAMA ,318 SHELLHARBOUR ,468 1,220 2,034 1,622 6,226 NOWRA- BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ,691 1,245 3, , ,454 3,186 3,995 2,465 12, , ,036 2,227 1,017 2, ,602 1,988 2,967 3,288 11,796 ISML Catchment 1,098 1,935-3,110 5,765 8,010 13,773 10,215 37,686 Source: NSW Department of Planning, 2010 The additional resident population numbers based on the above projections would be shared amongst the four major areas of the Illawarra-Shoalhaven in the following proportions: Figure 4: Share of projected additional residents, ISML areas, Hence ISML primary population health planning and primary health service delivery would be palnned and actioned in accordance with the above indicated population growth figures. Page 11

12 2.3. Population diversity and target groups The resident population of the ISML catchment is represented by several diverse population groups. The cultural, ethnic and socio-demographic diversity of the catchment s population is one of the prime reasons why ISML will use the population health approach to identify local needs and inform the development of focused and responsive primary care services that would holistically cater to all targeted niche groups and populations within the catchment Culturally and linguistically diverse (CALD) communities There is a significant proportion of the ISML population that is identified as being of non- English speaking background (NESB). This includes people born overseas in predominantly non-english speaking countries who have migrated to Australia and are currently residing within the ISML catchment (as identified during Census data collections 2011). The percentage of NESB population in the ISML catchment is below the NSW state and Australian national averages. However, with the University of Wollongong and its full services equipped campus at the Shoalhaven area attracting several international students and researchers each year, the numbers in the CALD community are expected to continue rising. In addition, the Illawarra-Shoalhaven is also expected to receive an inflow of a significant number of refugee populations in the coming years. According to the NSW Health Refugee Health Plan 3, Wollongong has been one of the prime areas to receive significant numbers of newly arrived refugee and humanitarian entrants seeking initial settlement in rural and regional areas of NSW. Hence ISML healthcare planning aims to be mindful of these circumstances and the impending increase of the NESB population in the catchment. Table 6 shows the figures for the NESB population in the ISML catchment compared to NSW and Australia. Figure 5 maps the concentration distributions of NESB populations in the ISML regions. Table 6: Non-English speaking background (NESB) population, ISML regions, 2011 REGIONS Total NESB % of total population JERVIS BAY KIAMA SHELLHARBOUR 6, NOWRA-BOMADERRY 1, SHOALHAVEN Balance 3, WOLLONGONG Inner 15, WOLLONGONG Balance 12, ISML Catchment 38, New South Wales 3,380, Australia 1,288, Source: ABS Census 2011 Page 12

13 Figure 5: Map of culturally and linguistically diverse population, ISML regions, 2011 percentages of total population A major reason for ISML to focus its population health planning on CALD communities is to improve primary healthcare delivery within the region amongst populations that have been identified as being at a relative disadvantage in terms of accessing quality healthcare. Recent research evidence is suggestive of improved clinical outcomes and patient satisfaction with received care through implementation of language interpretation services for multilingual consumers or persons having limited English language proficiency 4. With a significant number of the ISML catchment population identifying as having poor proficiency at speaking English, ISML population health planning will attempt to seek ways of adopting language interpretation services within general practice to improve community health outcomes and ease service delivery to niche groups. Table 7 below shows the number and percentage of persons with poor proficiency at speaking English in the ISML regions. Page 13

14 Table 7: Poor proficiency at speaking English, ISML regions, 2011 REGIONS Persons who speak English not well or not at all % of all persons aged five years and over JERVIS BAY KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner 2, WOLLONGONG Balance 2, ISML Catchment 6, New South Wales 513, Australia 218, Source: ABS Census Indigenous population Indigenous populations form a significant proportion of the ISML catchment. Indigenous refers to persons identified as being of Aboriginal and/or Torres Strait Islander origin as identified by the 2011 Census conducted by the Australian Bureau of Statistics (ABS) figures identify 3.0% of the ISML catchment population to be of Aboriginal or Torres Strait Islander origin. This is higher than both the NSW state and Australian national averages, both of which are estimated to be 2.5% of the respective populations identified as Indigenous in The Nowra-Bomaderry region has the highest proportional share of Indigenous population with 7% of its residents identified as Indigenous as per the 2011 ABS Census. While the concentration distribution of Indigenous persons is significantly higher within the Shoalhaven area with 7% of its resident population being Indigenous, the Illawarra region comprising the Wollongong, Kiama and Shellharbour areas has almost 59% of the total Indigenous population of the Illawarra-Shoalhaven catchment. The Shoalhaven area along with the Jervis Bay region account for the rest of the 41% of the Indigenous population of the ISML catchment. Table 8 shows the gross numbers and proportional percentages of the Indigenous population of ISML compared to NSW and Australia. Figure 6 maps the concentration distributions of the Indigenous population in the ISML regions. With a dedicated Closing the Gap team, the Popullation Health initiatives of the Illawarra- Shoalhaven Medicare Local will aim to keep the healthcare needs of the indigenous community of the catchment in the forefront and plan service delivery accordingly. Page 14

15 Table 8: Indigenous population, ISML regions, 2011 REGIONS Indigenous persons % of total population JERVIS BAY KIAMA SHELLHARBOUR 1, NOWRA-BOMADERRY 2, SHOALHAVEN Balance 1, WOLLONGONG Inner 1, WOLLONGONG Balance 2, ISML Catchment 10, New South Wales 172, Australia 548, Source: ABS Census 2011 Figure 6: Map of Indigenous population, ISML regions, 2011 percentage of total population Page 15

16 The age distribution of the Indigenous population in the Illawarra-Shoalhaven differs markedly from the age distribution of the non-indigenous population. The age bracket of 0-19 years of age, accounts for almost 49% of the Indigenous population of ISML. Figure 7 below illustrates the wide differences in age structure of Indigenous persons within the Illawarra-Shoalhaven compared to non-indigenous persons. The marked differences in older ages are primarily due to the differences in life expectancy between Indigenous and non- Indigenous Australians. Figure 7: Age distribution comparison of Indigenous and non-indigenous population, ISML catchment, 2011 Source: ABS Census Aged population Australia has long-standing demographic trends of an ageing population and lower birth rates 5. With life expectancy figures rising consistently and falling birth rates constantly standing at below replacement levels, Australia s population is ageing rapidly. This is hence a prime healthcare focus for all health services in Australia and also the rationale for the ISML to focus on the ageing population within the adopted population health approach to primary care planning. In 2011 it was estimated that 17.6% of the ISML catchment population were aged 65 years and above. This is significantly higher than the NSW state average of 14.5% and the Australian national average of 13.8%. Within the ISML catchment the Shoalhaven Balance region has the highest proportion of old aged residents with 26.1% of the population being aged 65 years and above. The Kiama region is placed second with an estimated figure of 20.1% of the population aged 65 years and above. Table 9 shows the proportions of aged population for all ISML regions. Figure 8 maps the concentration distributions of the population aged 65 years and above in the ISML regions. Page 16

17 Figure 8: Map of population aged 65 years and above, ISML regions, 2011 percentage of total population Table 9: Population aged 65 years and above, ISML regions, 2011 REGIONS 65 years and above % of total population JERVIS BAY KIAMA 4, SHELLHARBOUR 9, NOWRA-BOMADERRY 5, SHOALHAVEN Balance 16, WOLLONGONG Inner 16, WOLLONGONG Balance 15, ISML Catchment 67, New South Wales 1,044, Australia 3,076, Source: ABS 2012 Page 17

18 It is also estimated that 64% of the additional projected population of 2021 will be aged 65 years and above. While the population of persons aged 65 years and over in the Illawarra-Shoalhaven is projected to grow at an average annual growth rate of 3.1% till 2021, the Nowra-Bomaderry region is projected to have the highest growth with an overall increase of 50.3% by Table 10 shows these population changes for persons aged 65 years and over. Table 10: Population projections for persons aged 65 years and above, ISML regions, 2021 REGIONS 2011 ERP 2021 projected no. Change (%) Average annual growth rate (%) KIAMA 4,183 5, SHELLHARBOUR 9,314 12, NOWRA-BOMADERRY 5,834 8, SHOALHAVEN Balance 16,080 22, WOLLONGONG Inner 16,626 19, WOLLONGONG Balance 15,725 21, ISML Catchment 67,781 91, New South Wales 1,044,323 1,398, Table 10: Calculations based on Table 4 Consequently the projections for persons aged 85 years and over are even higher with their population projected to grow at an average of 4.2% annually leading to a 50.3% increase in the overall figures for the ISML catchment. Table 11 shows these population changes for persons aged 85 years and over. Table 11: Population projections for persons aged 85 years and above, ISML regions, 2021 REGIONS 2011 ERP 2021 projected no. Change (%) Average annual growth rate (%) KIAMA SHELLHARBOUR 913 1, NOWRA-BOMADERRY 769 1, SHOALHAVEN Balance 1,820 2, WOLLONGONG Inner 2,451 3, WOLLONGONG Balance 1,839 3, ISML Catchment 8,397 12, New South Wales 140, , Table 11: Calculations based on Table 4 Page 18

19 Single parent population Table 12 indicates that the Illawarra-Shoalhaven has a higher proportion of single parent population compared to the NSW state and Australian national averages. Apart from Jervis Bay, the Shellharbour region has the highest proportion of single parents in the catchment. Table 12: Single parent population, ISML regions, 2011 REGIONS Total single parents % total population above 15 years JERVIS BAY KIAMA SHELLHARBOUR 3, NOWRA-BOMADERRY 1, SHOALHAVEN Balance 2, WOLLONGONG Inner 4, WOLLONGONG Balance 4, ISML Catchment 17, New South Wales 297, Australia 901, Source: ABS Census 2011 An even more sensitive indicator is the proportion of single parent families with children under the age of 15 years. Table 13 shows that figures for this indicator are significantly higher for the ISML catchment compared to both the NSW state and Australian national average. Table 13: Single parent families with children aged below 15 years, ISML regions, 2011 REGIONS Single parent families with children under 15 years % of total families with children under 15 years JERVIS BAY KIAMA SHELLHARBOUR 1, NOWRA-BOMADERRY 1, SHOALHAVEN Balance 1, WOLLONGONG Inner 2, WOLLONGONG Balance 2, ISML Catchment 9, New South Wales 151, Australia 472, Source: ABS Census 2011 Page 19

20 Regional or remote populations Health care services can often be relatively inaccessible for persons residing in regional and remote places. The ISML catchment population structure has been quantified according to the current Remoteness Structure as per the Australian Standard Geographical Classification According to this classification 5 Remoteness Areas (RA) have been formulated where each RA represents an aggregation of non-contiguous geographical areas which share common characteristics of remoteness. The population distribution of ISML indicates a little over 31% of the population being in Inner Regional areas (RA2) and 0.06% residing in Remote areas (RA3). The RA3 sections, even though negligible, belong to the Shoalhaven Balance region. These regional population variations by RA categories are shown in Table 14 below. Table 14: Population by remoteness categories, ISML, 2011 RA Category RA category Name Population %of ISML total RA1 Major cities of Australia 264, RA2 Inner regional Australia 119, RA3 Outer regional Australia RA4 Remote Australia 0 0 RA5 Very remote Australia 0 0 Source: ABS 2013 Page 20

21 3. SOCIO-ECONOMY Socio-economic equity and addressing the disparities of the social determinants of health will be the prime focus of the ISML Population Health approach to primary healthcare planning. Under this methodology, ISML aims to evaluate several measures of socio-economic status of regions in our catchment. One important resource is the Socio-Economic Indexes for Areas (SEIFA) Scores that is prepared by the Australian Bureau of Statistics (ABS) 7 by populationweighted averages of scores of Census Collection Districts (CDs) in Australia. The reference value for the whole of Australia is set to Lower values indicate lower socio-economic status. Table 15 shows the 2011 Index of Relative Socio-Economic Disadvantage SEIFA scores for all regions of the ISML catchment and their national and state rankings in order of being the most socio-economically disadvantaged SLA in Australia, as estimated in Table 15: Index of relative socio-economic disadvantage, ISML regions, 2011 REGIONS SEIFA score Australia ranking NSW state ranking JERVIS BAY KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance Source: ABS 2013 Overall the ISML catchment continues to have higher unemployment rates and lower labour force participation rates than both the NSW state and Australian national averages. Table 16: Unemployment rate and labour force participation, ISML regions, June 2011 REGIONS Unemployment rate (%) Labour force participation (%) KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: DEEWR Report June 2011 Page 21

22 While research has proven that unemployment is strongly associated with poor physical and mental health, 8 9 the health and social impacts of unemployment are reported to be even more catastrophic for children within jobless families. In 2011 it was found that within the Illawarra-Shoalhaven 16.2% of all children below 15 years of age belonged to jobless families, with 15.9% of all jobless families having to support children under the age of 15 years. Apart from the Jervis Bay region, both these indicators were reported to be the highest for the Nowra-Bomaderry region, with the ISML average being higher than both the NSW and Australian averages. Table 17 shows the findings across the region for both these indicators with comparisons across state and national figures. Table 17: Jobless families and children under 15 years of age, ISML regions, 2011 Families Children REGIONS Jobless families with children under 15 years % of total families with children under 15 years Children under 15 years in jobless families % of total children under 15 years JERVIS BAY KIAMA SHELLHARBOUR 1, , NOWRA-BOMADERRY , SHOALHAVEN Balance , WOLLONGONG Inner 1, , WOLLONGONG Balance 1, , ISML Catchment 5, , New South Wales 100, , Australia 294, , Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published 2013 While unemployment figures indicate a significant disadvantage within the population, very low income earners are also at a high level of social disadvantage that ultimately leads to poorer health status. This is also a prime focus for the ISML Population Health approach in order to make primary health care services affordable and accessible for the entire population. While the poverty line benchmark for single adults ranges between $358 to $ per week depending on the sources and inclusions such as housing, persons with a personal income of below $300 per week have been identified as very low income earners. Table 18 indicates the number of persons earning less than $300 per week (less than $15,600 per annum) and their percentage within the eligible for earning total population i.e. persons aged above 15 years of age. The Shoalhaven Balance region has the highest proportion of very low income earners followed by Shellharbour. The Illawarra- Shoalhaven overall has a higher percentage of very low income earners than both the NSW state and Australian national average. This increases the socio-economic disadvantage of the Illawarra-Shoalhaven residents in addition to the existing high unemployment rates across the region as indicated in Table 16. Page 22

23 Table 18: Very low income earners (less than $300 per week), ISML regions, 2011 REGIONS Low Income Earners % total population above 15 years JERVIS BAY KIAMA 4, SHELLHARBOUR 14, NOWRA-BOMADERRY 7, SHOALHAVEN Balance 15, WOLLONGONG Inner 23, WOLLONGONG Balance 21, ISML Catchment 87, New South Wales 1,481, Australia 4,499, Source: Statistically modeled from ABS Census 2011 A more specific indicator of economic hardship constructed by the Australian Bureau of Statistics is the gross household weekly income 12. Using the median equivalised disposable household income for all households in NSW of $676 per week 12, comparisons across the ISML region for percentage of households with gross weekly incomes of below $600 are shown in Table 19. As gross numbers cannot compare income levels between households of differing size and composition, an equivalised figure derived from applying the 'modified OECD' equivalence scale 15 has also been shown in Table 19. Table 19: Low income households (less than $600 per week), ISML regions, 2011 REGIONS % total households with income below $600 per week as per: - Gross Household Income Equivalised Household Income JERVIS BAY KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: Statistically modeled from ABS Census 2011 Page 23

24 The above illustrated economic indicators lead to wider impacts on several health and social inequalities through various interdependent factors. The most vital ones of these have been grouped in the following themes for the purposes of assisting ISML in designing focused population health strategies Access Access to affordable and responsive transport is a significant problem for many ISML catchment residents. The Illawarra-Shoalhaven geography and a limited public transport system, especially in remote and isolated communities, make it difficult for many people to easily access health services. These issues are heightened in the rural areas, particularly among Indigenous communities. For example, those living at the most southern part of the Shoalhaven need to travel more than 100km to the Shoalhaven District Memorial Hospital in Nowra, and a further 75-80km to Wollongong hospital ABS data suggests that 9.1% of households within the Illawarra-Shoalhaven did not have a motor vehicle, with the percentage being highest for the Wollongong Inner region. Access to non-urgent health care services from both outer metropolitan and regional areas is impacted significantly by access to private transport and easily accessible and affordable public transport options. Table 20 shows the numbers and percentages of households with no motor vehicle within the Illawarra-Shoalhaven. ISML will continue to work with the Illawarra-Shoalhaven Local Health District (ISLHD) to seek improvements in the public transport infrastructure in the catchment, addressing the inequities in health access, that occur due to the lack of appropriate public transport, especially for the Shoalhaven area, and the absence of motor vehicle ownership by a segment of the population as shown in Table 20. Table 20: Private dwellings with no motor vehicle, ISML regions, 2011 REGIONS Occupied private dwellings with no motor vehicle % of total occupied private households JERVIS BAY KIAMA SHELLHARBOUR 1, NOWRA-BOMADERRY 1, SHOALHAVEN Balance 1, WOLLONGONG Inner 5, WOLLONGONG Balance 3, ISML Catchment 12, New South Wales 258, Australia 665, Source: ABS Census 2011 Telecommunication and e-health solutions to primary health care delivery are two of ISML s prime focuses under the Population Health approach and are being envisaged by ISML to reduce the inequity in health care access across the catchment s geography, especially to regional communities. ISML aims to investigate solutions to inaccessibility of healthcare through advocating and assisting in uptake of e-health initiatives by primary health care professionals within the catchment. ISML will devote conscious efforts into bringing e-health Page 24

25 and telehealth options to populations with limited health access. This is in line with the National Broadband Network (NBN) roll out that has already commenced in the Kiama area and parts of Shellharbour and Wollongong, focusing on the delivery of high quality NBN enabled telehealth services in-home to older Australians with chronic conditions. 13 As broadband internet connection allows households to access a vast range of communication tools and offers the potential to improve access to health care through communication solutions, households without any internet connectivity will be a prime focus of ISML s population health and primary health delivery planning ABS data suggests that 23.6% of households across the ISML catchment did not have any form of internet connectivity. This is higher than both the NSW state and Australian national averages. Table 21 shows the numbers and percentages of households with no internet connection within the ISML catchment. The Nowra-Bomaderry region emerges as having the highest percentage of private households with no internet connectivity. Table 21: Private dwellings with no internet connection, ISML regions, 2011 REGIONS Occupied private dwellings with no internet connection % of total occupied private households JERVIS BAY KIAMA 1, SHELLHARBOUR 5, NOWRA-BOMADERRY 2, SHOALHAVEN Balance 6, WOLLONGONG Inner 8, WOLLONGONG Balance 7, ISML Catchment 32, New South Wales 495, Australia 1,525, Source: ABS Census 2011 As indicated in Section 2 of this report (Demography), the Illawarra-Shoalhaven catchment has a large proportion of identified target population groups such as the aged population, indigenous persons and single parent populations; who also represent socio-economically disadvantaged groups in terms of gaining access to affordable health and social services. Through the Centrelink program, the Department of Human Services delivers a range of payments and services for such niche population groups such as retirees, the unemployed, families, carers, parents, people with disabilities, Indigenous Australians, and people from diverse cultural and linguistic backgrounds. While these payments are aimed to enable disadvantaged persons to afford and access health and social services; they have always been empirically proven indicators of socio-economic disadvantage 34. Table 22 below shows the latest 2011 data on the major population groups receiving any form of income support from Centrelink, and their proportions for all the ISML regions compared with the NSW state and Australian national percentages. Across all the centrelink income recipient groups the Page 25

26 percentages for the ISML catchment are much higher than the NSW and Australian averages. Table 22: Centrelink income support recipients, ISML regions, 2011 REGIONS Age pensioner (% of 65 years & Above) Disability support pensioners (% of years aged) Female sole parent pensioners (% of females years) Long-term unemployment benefit recipients (% of years aged) Youth unemployment benefit recipients (% of years aged) Welfaredependent families (with children) (% of all families) KIAMA SHELLHARBOUR NOWRA- BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published The above mentioned indicators play a mojor role in the accessibility and affordability of healthcare services for the significantly high proportion of the ISML population that are affected by these indicators. These findings in addition to the high rates of unemployement in the catchment and the high proportions of low income earning persons and households as identified earlier in this section of the report; present an escalating challenge for primary healthcare planners and service providers to deliver socially and economically equitable primary healthcare to the Illawarra-Shaoalhven community. Furthermore, it is well known that access to timely, effective and cost-efficient healthcare services is also dependent on an individual s ability to afford private health insurance. Hence, this leads to health insurance being a key indicator of inequality in the community. Table 23 shows the synthetic estimates based on the 2007 ABS National Health survey and indicates much lower coverage rates for ISML compared to the NSW state and Australian national rates. Additionally, the 2009 data for the percentage of health care card holders issued by the Department of Human Services also indicates a high proportion of low income earners aged below 65 years of age in the Illawarra-Shoalhaven who receive Centrelink payments and therefore concessions on health care costs. Table 23 illustrates these indicators across all regions within the Illawarra-Shoalhaven catchment. Page 26

27 Table 23: Private health insurance and health care card coverage, ISML regions REGIONS Health Care Card holders (% population aged 0-64 years), 2011 Private Health Insurance Holders (ASR per 100), JERVIS BAY KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published Refer to KEY 3.2. Education Education is a strong determinant of income and social status. As shown in Figure 9, 52% of the ISML catchment population is estimated to have Year 10 or less as their highest year of school education, as per the ABS 2011 Census. Figure 9: Highest year of schooling completed, ISML catchment, 2011 Source: ABS Census 2011 Page 27

28 Education is of prime importance for young people and is significantly instrumental in building a healthy and prospering community. In 2011 it was estimated that 76.4% of the ISML catchment population aged years was enrolled in some kind of education institute, either full-time, part-time or neither but enrolled. It was also estimated that 28.3% of the population aged years were enrolled in some form of higher education such as university/other tertiary institution and/or technical/further education institutes (incl. TAFE colleges), while 79.6% of the population aged years were learning or earning by being engaged in school, work or further education/training. Table 24 shows the participation in any form of education for persons aged 16 years and for school leavers (majority aged 17 years) along with learning or earning status of 15 to 19 year olds. Given that the University of Wollongong has its major campus in the Wollongong Inner region and that TAFE and other educational avenues are also located in the Wollongong Inner region, the education enrolment percentages are highest for this region, along with Kiama, amongst all other ISML catchment regions. While figures of participation in full-time education at age 16 years is higher for the Illawarra-Shoalhaven than NSW state and Australian averages; the figures for school leavers participation in higher education is very low for the region. Additionally figures are the lowest for the Nowra-Bomaderry region which are estimated to be only 17.2% compared to the Australian national average of 30.4%. The Nowra-Bomaderry region also has the lowest percentage of young adults engaged in some form of learning or earning at ages 15 to 19. Table 24: Youth participation in education, ISML regions, 2011 & 2012 REGIONS % of full-time participation in any form of education at age 16 in 2011 % learning or earning at ages 15 to 19 in 2011 % school leavers in higher education in 2012 JERVIS BAY NA KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia* * Excludes Queensland Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published 2012 and Early childhood indicators The early childhood period is considered by the World Health Organisation to be the most important developmental phase throughout the lifespan and hence early childhood development has been identified as a key theme of the several social determinants of health 14. A vital indicator of community health that is drawn from early childhood access to Page 28

29 health services is the regional immunisation coverage rates. While the Shoalhaven area has consistently ranked amongst the top 10 regions in NSW (divisions based ranking), the Illawarra has scope to further enhance coverage in the Wollongong, Kiama and Shellharbour areas. With a 91.6% figure for overall coverage, the Shoalhaven ranked 9 th in all NSW divisions as of August 2012, as per initial assessments of the General Practice NSW Immunisation Program conducted by GPNSW. The Illawarra, however, ranked 15 th with an overall coverage figure of 90.9%. Figure 10 shows the trends in percentage of fullimmunisation coverage for the Illawarra and Shoalhaven compared to the NSW state and Australian national averages. Figure 10: Immunisation coverage* (%), ISML, latest financial quarters *Initial Counts ONLY. Re-calculations are NOT included. Source: GPNSW, 2012 In addition to immunisation, empirical evidence also suggests that the early years of a child s life play a major role to play in their future health, development, learning and wellbeing 21. Early childhood development outcomes are considered to be vital markers of the welfare of children, and definite predictors of their future health and well-being. In 2012 the Australian Early Development Index (AEDI) was completed across all regions in Australia for the second time, providing an updated review of the picture of early childhood development outcomes for Australian children. The AEDI measures five key domains of early childhood development: physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based), and communication skills and general knowledge which are assessed through a teacher-completed checklist. Table 25 shows the percentage of children found to be developmentally vulnerable and Table 26 illustrates the proportions of developmental vulnerability on single and multiple domains for school children in the ISML catchment areas compared to NSW state and Australian national figures. While overall the ISML catchment average is lower than NSW state and Australian national averages and, within the catchment the Shellharbour and Shoalhaven community figures reveal the maximum proportions of developmental Page 29

30 vulnerability amongst school children. The Shellharbour area also fares the worst in terms of developmental vulnerability on multiple domains, with figures close to that of the Australian national levels. These data indicate a need to investigate childhood health and wellbeing issues especially for the Shellharbour and Shoalhaven regions. Table 25: Developmental vulnerability in school children by domains, ISML areas, 2012 AREAS Physical health and wellbeing Proportion of children developmentally vulnerable (%) Social competence Emotional maturity Language and cognitive skills (school-based) Communication skills and general knowledge KIAMA SHELLHARBOUR SHOALHAVEN WOLLONGONG ISML Catchment* New South Wales Australia *Average of individual community proportions. Source: AEDI, 2013 Table 26: Developmental vulnerability in school children by no. of domains, ISML areas, 2012 AREAS Proportion of children developmentally vulnerable (%) On 1 or more domains of the AEDI On 2 or more domains of the AEDI KIAMA SHELLHARBOUR SHOALHAVEN WOLLONGONG ISML Catchment* New South Wales Australia *Average of individual community proportions. Source: AEDI, Housing and social isolation Homelessness and poor housing and living conditions have been identified as major risk factors for poor health and well-being 22. Recent estimates drawn by the ABS identify that there were more than 105,000 homeless people across Australia on Census night, People experiencing homelessness face a range of problems including unemployment, substance abuse and mental health problems. Empirical evidence suggests that strong interaction between individual and structural factors contribute to a high rate of mental illness among people who are homeless 16. The ISML catchment has experienced a rise of 66.2% in the homelessness count as estimated in The Wollongong area has the highest gross number of homeless persons in the catchment. While almost 0.5% of the population of the Wollongong area have been identified as being homeless, it should be noted that observing homeless people in any data Page 30

31 collection is a challenge and their homeless circumstance may mean that these people are not captured at all in datasets used to count people generally. Adding to this is the number of persons residing in inadequate housing arrangements like caravan parks etc, hence it becomes a major concern for health and social planners. Table 27 shows the most recent estimated homelessness figures for the ISML catchment. Reducing homelessness is a major policy driver for all sections of social and economic development and relies on the collaborated efforts of national, state and local governments along with relevant NGOs and community service providers. However the health impacts of homelessness and its effects on health services are an identified issue for all health service planners and hence with a population health approach, ISML will be mindful of the figures of Table 27 to plan the access and distribution of community care services for the catchment. Table 27: Homelessness^, ISML areas, 2011 AREAS Homeless persons % increase since last official count (2006) KIAMA -&- SHELLHARBOUR SHOALHAVEN WOLLONGONG ISML Catchment 1, New South Wales 28, Australia 105, ^ Includes only persons defined as Homeless as per the ABS definition of Homelessness Source: ABS 2012 In addition to the health effects of homelessness, researchers have also identified social isolation in the elderly as a major health risk factor and argue that it is more harmful than not exercising and twice as harmful as obesity 31. Table 28 indicates the prevalence of social isolation in persons aged 65 years and over within the ISML catchment regions. Table 28: Social isolation in older ages, ISML regions, 2011 REGIONS Persons aged 65 years and over living alone in the community % of total persons aged 65 years and over JERVIS BAY KIAMA SHELLHARBOUR 2, NOWRA-BOMADERRY 1, SHOALHAVEN Balance 3, WOLLONGONG Inner 4, WOLLONGONG Balance 3, ISML Catchment 15, New South Wales 239, Australia 719, Source: ABS Census 2011 Page 31

32 As identified in Table 18 and Table 19, there are a significant number of low income earners and low income households in the ISML catchment. Such low earning households often struggle to keep up with mortgage or rent payments. This invariably leads to mental stress which is a known precursor of multiple mental disorders and chronic diseases 17. It is also considered to be a predisposing factor for suicidal ideation, substance abuse and family violence 18. Households in the bottom 40% of income distribution spending more than 30% of income on mortgage repayments or rent have been illustrated in Table 29. Table 29: Housing stress in lower income households^, ISML regions, 2011 REGIONS Low income households Mortgage stress % of all mortgaged private dwellings Low income households Rental stress % all rented private dwellings JERVIS BAY KIAMA SHELLHARBOUR , NOWRA-BOMADERRY , SHOALHAVEN Balance , WOLLONGONG Inner , WOLLONGONG Balance 1, , ISML Catchment 4, , New South Wales 92, , Australia 286, , ^ Includes households in the bottom 40% of income distribution (those with less than 80% of median equivalised income) spending more than 30% of income on mortgage repayments or on rent. Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published 2012 The ISML Population Health and Primary Health Planning processes will focus on all the aforementioned demographic, social and economic indicators illustrated in Section 2 and 3 of this Population Health Profile: 2013 to undertake a comprehensive qualitative assessment of needs and service gaps perceived by the local community and the key stakeholders of healthcare delivery within the ISML catchment. The analysis of the stakeholder and community perceived needs, in addition to all the information presented in this Population Health Profile: 2013 will be utilised by ISML to plan future service delivery so as to better meet the needs of the local community. Page 32

33 4. HEALTH STATUS, DISEASE BURDEN AND EPIDEMIOLOGY This section of the Population Health Profile: 2013 identifies the key health indicators that exist within the population of the ISML catchment. NOTE: Refer to KEY for all Table Indicator Abbreviations Average indirect standardised death rates and total fertility rates (TFR) are calculated and reported by the Australian Bureau of Statistics (ABS) for each year using data for the three years ending in the reference year. The TFR is a synthetic rate and indicates an expected number of babies a woman would have if age-specific fertility rates for the reference year were to be extrapolated to her entire reproductive life span. The death rate however is a standardised crude rate for all persons in the region figures show that while the TFR is only slightly higher, the death rates for the ISML catchment are significantly higher than state and national levels. The Nowra-Bomaderry region has the highest rates for both indicators. Table 30: Births and total fertility rates, ISML regions, 2011 REGIONS Total births Total fertility rate KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner 1, WOLLONGONG Balance 1, ISML Catchment 4, New South Wales 99, Australia 301, Source: ABS 2012 Table 31: Mortality and standardised death rates, ISML regions, 2011 REGIONS Total deaths ISDR/1000 KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment 3, New South Wales 50, Australia 146, Source: ABS Refer to KEY Page 33

34 Data describing avoidable mortality between the ages of 0 and 74 years from causes that could have potentially been averted are included in Table 33. By removing deaths occurring over the age of 75, a more sensitive analysis can be presented than for overall mortality as shown above in Table 33. Table 32 shows the Smoothed Estimate of Standardised Mortality Ratio (SESMR) from all avoidable causes of mortality for the latest available year compared with NSW state ratios. Table 33 displays the Standardised Mortality Ratio (SMR) separately for major causes such as cancer, cardiovascular disease, respiratory disease, suicide and self-inflicted injury and motor vehicle accidents for The ratios for the Kiama region are significantly lower, both overall and for most causes. The Shellharbour region has highest ratios for avoidable mortality overall as well as for cancer and cardiovascular diseases. The Nowra-Bomaderry region has an extraordinarily high SMR (144) for motor vehicle injuries and the highest SMR for deaths due to suicide and self-inflicted injury. Table 32: Avoidable deaths, ISML Areas, AREAS SESMR Compared to NSW KIAMA 67 Lower SHELLHARBOUR Higher SHOALHAVEN Nil WOLLONGONG Nil Source: NSW Ministry of Health Refer to KEY Table 33: Avoidable deaths and major causes, ISML regions, REGIONS Cancer specific SMR Cardiovascular disease specific SMR Respiratory disease specific SMR Road traffic accidental SMR Suicide and self-inflicted injuries SMR KIAMA 73* 66* 46 NA NA SHELLHARBOUR 117* NOWRA- BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment 106* * 93 New South Wales Australia *statistically significant, at the 95% confidence level **statistically significant, at the 99% confidence level Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published Refer to KEY According to 2011 figures the prevalence of profound or severe disability within the ISML catchment exceeds both the NSW state and Australian national averages as shown in Table 34. While 6% of the overall population reported having a severe or profound disability in 2011, the percentage for the older population aged 65 years and above was estimated to be 19%. While the Shoalhaven Balance region had the highest prevalence of disability at 7%, Page 34

35 the Wollongong Balance region had the highest percentage for disability within persons aged 65 years and over, estimated at 22.4%. Table 34: Disability^ within the general and the aged population, ISML regions, 2011 REGIONS Overall^ % of total population Aged 65 years and over JERVIS BAY KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia ^ Includes people with profound or severe disability living in long-term residential accommodation in nursing homes, accommodation for the retired or aged (not self-contained), hostels for the disabled and psychiatric hospitals along with those living in the community. Source: ABS Census 2011 While the health and social needs of people with profound or severe disability is definitely higher than the general population; the health and well-being of carers who provide the required attention and assistance to disabled persons is also very important. Recent research done by the Australian Institute of Family Studies (AIFS 2008) 35 revealed that carers had significantly worse mental and physical health status than the general population. Hence support for care providers and their health and well-being is very vital in maintaining a healthy and viable carer population which therby can lead to better and sustainable care for disabled persons. Figure 11 shows the population proportions of carers providing unpaid assistance to disabled people within the ISML catchment compared to NSW and Australia. Figure 11: Carer population proportions and disability prevalence, 2011, ISML regions Source: GPNSW, 2012 Page 35

36 Table 35 shows the 2011 prevalence figures for the major risk factors that influence health across the ISML catchment compared to the NSW state average. Indicators where the ISML catchment population is estimated to fare poorly compared to NSW state are highlighted in red. More than 57% of the ISML catchment population is estimated to be either obese or overweight, almost 36% of the population was found to engage in high risk alcohol drinking behaviour and 12% of the population reported having a higher range of psychological distress. Table 35: Estimated prevalence of major health risk factors, ISML, 2011 Indicator ISML catchment (%) NSW (%) Adequate fruit consumption Adequate physical activity Adequate vegetable consumption Overweight or obese Higher than recommended alcohol consumption Current smoking High or very high psychological distress Source: NSW Ministry of Health 2012 Table 36 illustrates the 2010 prevalence of vital maternal and child health indicators in the ISML catchment compared to NSW state averages. The ISML catchment population is estimated to fare better than NSW in most indicators except the prevalence of pre-term births which is estimated at 8% compared to 7.3% for NSW. Table 36 Estimated maternal and child health indicators, ISML, 2010 Indicator ISML catchment (%) NSW (%) First antenatal visit before 14 weeks First antenatal visit before 20 weeks Smoking at all during pregnancy Low birth weight* Pre-term births* * Includes Source: NSW Ministry of Health 2012 On a regional level, the above mentioned health risk indicators are available only as synthetic estimates drawn from the Australian National Health Survey conducted by the Australian Bureau of Statistics (ABS). Table 37 shows these estimates for some of the major health risks within the ISML catchment. While Shellharbour region has the worst figures for obesity in both genders, the Shoalhaven area, comprising the Nowra-Bomaderry and Shoalhaven Balance regions, emerges as having the worst figures for most of the other indicators within the ISML catchment. The overall average synthetic estimates for the ISML catchment are also significantly worse than NSW state and Australian national estimates. Page 36

37 Table 37: Synthetic prevalence estimates of major risk factors and maternal and child health indicators, ISML regions, REGIONS Current smoking (ISR/ 100) High risk alcohol consumption (ISR/ 100) Physical inactivity (ISR/ 100) Adequate fruit intake in children (ISR/ 100) Adequate fruit intake in adults (ISR/ 100) Low birth weight (%) Smoking during pregnancy (%) Obesity (ISR/ 100) Males Females KIAMA SHELLHARBOUR NOWRA- BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published Refer to KEY Health literature has stated on several occasions that health officials need to know the prevalence of infections and diseases in the population and the characteristics of those who are infected (risk groups) in order to effectively plan public health programs 32. Table 38 shows the synthetic prevalence estimates for the major disease groups for the ISML regions. Consistent with the health risk findings, the Shoalhaven area comprising the Nowra- Bomaderry and the Shoalhaven Balance regions has the highest prevalence figures amongst all regions within the ISML catchment. The overall ISML average estimates are also reported to be higher than NSW state and Australian national figures. Table 38: Synthetic prevalence estimates of major chronic disease groups, ISML regions, REGIONS Circulatory system diseases (ISR/ 100) Respiratory system diseases (ISR/ 100) Musculoskeletal system diseases (ISR/ 100) KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published Refer to KEY Page 37

38 With a dedicated chronic care stream and a mental health nursing stream, the population prevalence of chronic diseases and mental health disorders is a prime focus of ISML health and service delivery planning. Table 39 identifies the major chronic conditions prevalent within the ISML catchment and shows the synthetic prevalence estimates of each of them compared to the NSW state and Australian national prevalence figures. Figures for all conditions are higher within the ISML catchment compared to both NSW state and Australian national prevalence figures. The Nowra-Bomaderry region has the highest estimated figures amongst all ISML regions for Type 2 diabetes, high cholesterol, asthma and arthritis. While the Shoalhaven Balance region has the highest prevalence of hypertension, the Shellharbour region has the highest prevalence of chronic obstructive pulmonary disease (COPD) amongst all regions in the ISML catchment. Overall the figures for the Shellharbour and the Shoalhaven areas clearly indicate the urgent need for establishing preventive health strategies in these areas and that shall be a prime focus of the ISML Population Health and Primary Health plans and actions. Table 39: Synthetic prevalence estimates of specific chronic conditions, ISML regions, REGIONS Type 2 diabetes (ISR/ 100) High cholesterol (ISR/ 100) Hypertension (ISR/ 100) COPD (ISR/ 100) Asthma (ISR/ 100) Arthritis (ISR/ 100) KIAMA SHELLHARBOUR NOWRA- BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published Refer to KEY While prevalence figures for specific mental health disorders such as dementia, depression and anxiety are not available at the smaller geographic levels such as Statistical Local Areas, synthetic prevalence estimates of the two major ICD-10 groups of mental disorders have been constructed from responses to the Australian National Health Survey conducted by the Australian Bureau of Statistics (ABS). These groups are mental and behavioural problems and mood (affective) problems. Table 40 reveals that within the ISML catchment and consistent with national level findings, mental health conditions are more common amongst women than men. However, irrespective of gender, the estimated prevalence of both mental and behavioural problems as well as mood (affective) problems in Page 38

39 the ISML catchment, are reported to be higher than NSW state and Australian national figures. Within the catchment the Shoalhaven area overall has the highest figures for mental and behavioural problems for both genders and for mood problems in males, while the Shellharbour region has the highest estimated prevalence of mood problems in females. For a holistic assessment of mental health status within the regions of the ISML catchment, Table 40 also indicates the synthetic prevalence estimates of high to very high psychological distress for all the regions. The Kessler Psychological Distress Scale (K-10), which is a scale of non-specific psychological distress based on responses about negative emotional states, has been used to determine levels of psychological distress. Higher than state and national level scores are indicated for the ISML catchment with the Shellharbour region having the highest proportion of responders identified to have higher levels of psychological distress. Table 40: Synthetic prevalence estimates of mental health conditions, ISML regions, REGIONS Mental and behavioural problems (ISR/ 100) Mood (affective) problems (ISR/ 100) Male Female Male Female High or very high psychological distress (ISR/ 100) KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published Refer to KEY As identified in Table 33, cancer poses a substantial burden on the health status of the population of the ISML catchment. Table 41 shows the latest available data on cancer deaths and cancer incidence within the ISML catchment compared to NSW state figures. Directly standardised rates of mortality and incidence per 100,000 population are higher than the NSW state average for both indicators for lung cancer and colon cancer. Additionally as a category of hospitalisations in , malignant neoplasms and other forms of cancer conditions accounted for 5.6% of all hospitalisations within the Illawarra-Shoalhaven catchment. Hence in all indicators namely disease epidemiology, mortality and health service utilisation; cancer conditions poses a significant burden. Page 39

40 Table 41: Mortality and disease burden of major cancers, ISML, 2008 Mortality rate: DSR per 100,000 Incidence rate: DSR per 100,000 Top 5 Cancer Sites ISML NSW Top 5 cancer sites ISML NSW Lung Prostate Colon Breast Breast Melanoma Prostate Lung Pancreatic Colon Source: NSW Central Cancer Registry, Refer to KEY High rates of participation in cancer screening programs are vital for early diagnosis and for enhancing the efficiency of cancer treatment 33. Table 42 shows participation rates of Illawarra-Shoalhaven residents in screening for some of the major cancer groups as identified in Table 41 and that is compared to the participation rates of the NSW state overall. As data for breast cancer screening is not available for NSW, screening mammogram responses to surveys conducted by the NSW Ministry of Health have been used in Table 42 to give an approximate indicator of participation in breast cancer screening. Other than for cervical cancer, the ISML catchment s participation in cancer screening initiatives is estimated to be better than the NSW state average. Table 42: Participation in cancer screening, ISML, 2010 Cancer Screening Indicator ISML catchment (%) NSW (%) National Bowel Cancer Screening Program (NBCSP) Breast cancer screening in women aged years Cervical cancer screening in women aged years Screening mammogram in women aged years* * During the two years till the reference year. Source: Department of Health and Ageing 2012 and NSW Ministry of Health 2012 Disclaimer: Formal publication and reporting of the NBCSP data is undertaken by the Australian Institute of Health and Welfare on behalf of the Department of Health and Ageing. NBCSP data included in this report provided by the Department of Health and Ageing is not part of the formal publication and reporting process for NBCSP data. All the above illustrated health indicators identified in this section of the Population Health Profile: 2013, will be carefully examined and comprehensively considered for all ISML Population Health planning processes and to identify key health needs of the ISML catchment. The data presented in this section of the Population Health Profile: 2013 will be correlated with the socio-economic and demographic data illustrated in Sections 2 and 3 of this report, to identify key population health priorities for the Illawarra-Shoalhaven Medicare Local. Priority themes arising from the demographic, socio-economic and health and epidemiological segments of this Population Health Profile: 2013 have also been summarised in the concluding section of the document. Page 40

41 5. HEALTH SERVICES AND UTILISATION The diverse resident population of the ISML catchment utilises a range of health services that include primary care, acute and sub-acute care, and aged care. While primary care services come under the core business of the Illawarra-Shoalhaven Medicare Local, under the Population Health approach to primary healthcare planning, ISML also aims to consistently monitor and review the service utilisation figures for both the acute care and the aged care sectors Primary Care Figures for GP services under the Medicare Benefits Schedule (MBS) are released by the Department of Health and Ageing (DoHA) and are the best available estimates of service utilisation of GP services in the region. In the recently concluded financial year , the ISML catchment had a total of 2,079,097 counts of services under the category of General Practitioner and other non-referred attendances at a rate of per 100 population of the catchment. This is significantly higher than the NSW (Medicare Local regions) average rate of and the Australian (Medicare Local regions) average rate of services per 100 population. While research suggests that higher utilisation rates indicates socio-economically deprived groups having a higher utilisation of GP services than those who are at the less disadvantaged end of the spectrum 26, this is also affected by the supplier induced demands, availability and access of services, and the size of the primary care workforce. Hence correlations with socio-economic disadvantage and actual disease prevalence should be kept in mind while drawing conclusions from the MBS item utilisation service rates. Table 43 shows the service utilisation rates of all themes relevant to general practice within the ISML catchment for compared to the NSW and Australian averages. Table 43: Service utilisation rates by category of GP services, MBS Service Type* Utilization rates per 100 population ISML NSW Australia General Practitioner and other non-referred attendances After hours services Chronic disease-related services Mental health services Health assessment PIP incentive-related services Other *Service Type is based on the MBS book (Operating from 01 Jul 2012). Source: DoHA, MBS Statistics Financial Year. Rates have been calculated using 2011 ERP (ABS, 2012). Table 44 indicates the GP service utilisation figures for broken down by the regions of the ISML catchment. The figures indicate a significantly lower utilisation of services in the Page 41

42 Kiama and Shoalhaven Balance regions and a significantly higher utilisation in Shellharbour, Wollongong - Inner and Wollongong - Balance regions. Table 44: GP service utilisations, ISML regions, REGIONS ASR per 1000 Total GP services SR KIAMA 4, SHELLHARBOUR 6, NOWRA-BOMADERRY 5, SHOALHAVEN Balance 4, WOLLONGONG Inner 5, WOLLONGONG Balance 6, ISML Catchment 5, New South Wales 5, Australia 5, Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published Refer to KEY Figures for GP services for enhanced primary care (EPC) items and practice nurse services under the MBS for have been shown in Table 45. Overall the utilisation rates for these services for the ISML catchment are higher than state and national averages. However significantly high rates for EPC items and practice nurse service utilisation in the Nowra-Bomaderry region may also indicate an above average need for services and an insufficient access to GP services leading to reliance on practice nurse-led patient care. Table 45: Utilisation of selected items specific to primary care services, ISML regions, REGIONS Services by GPs for enhanced primary care items Practice nurse services under the MBS ASR per 1000 SR ASR per 1000 SR KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published Refer to KEY Page 42

43 Allied Health services have a significant role within the primary care setting and by working alongside GPs and practice nurses, allied health professionals provide effective multidisciplinary care to patients. The MBS items uptake rates for the major allied health providers who are eligible to register wiith Medicare Australia are the best available indicator of allied health service ultilisation. These MBS group uptake figures will be used by the Population Health planning processes of ISML to identigy service gaps and plan for service delivery for the catchment. Table 46 shows these figures for the major Allied Health services as per the groups outlined by the Medicare Benefits Schedule. Table 46: Service utilisation rates by category of Allied Health services, MBS Service Type* (Based on the MBS group reporting categories) Utilization rates per 100 population ISML NSW Australia Physiotherapy Services Diabetes Education and Dietetics Services Podiatry Services Exercise Physiology, Occupational Therapy, Chiropractice, and Osteopathy Services Mental Health, Psychology, Audiology, Speech Pathology and Indigenous Health Services All Allied Health Services (TOTAL of ALL the ABOVE) Psychological Therapy Services - Services by Clinical Psychologists Focused Psychological Strategies - Services by Allied Health Providers Pregnancy Support, Allied Health Group Services, and Pervasive Development Disorder Allied Health Services for Indigenous Australians who have had a health check *Service Type is based on the MBS book (Operating from 01 Jul 2012). Source: DoHA, MBS Statistics Financial Year. Rates have been calculated using 2011 ERP (ABS, 2012). The data indicates lower than state and national average service utilisation rates for physiotherapy services and the allied heath provider component of mental health services, audiology and speech pathology services. It is also interesting to note that the indigenous health services component of the allied health provider services group along with the services for indigenous persons that have had a health check are lower for the ISML catchment as compared to NSW state and Australian national averages. While MBS item uptake is suggestive of higher number of services delivered within a region, care needs to be taken in making inferences from these figures as they do not necessarily highlight causality. A higher service uptake rate could be demand driven where the community faces higher health issues requiring allied health professional attendances and hence required more services; or could be supply driven, wherein higher than required claiming of MBS items may occur. Hence correlations of these service utilisation data with the socio-economic profile of the catchment and actual disease prevalence needs to be undertaken. Page 43

44 5.2. Acute and sub-acute care Acute and sub-acute inpatient care is provided by the Illawarra-Shoalhaven Local Health District (ISLHD) through a network of public sector hospitals, see below. Figure 12: Location of hospitals in the ISML catchment Source: DoHA 2011, Medicare Locals Hospitalisation rates Table 47 shows the hospitalisation rates for selected conditions that are believed to be most relevant for primary care planning purposes, across all areas of the ISML catchment. The rates for all areas have also been compared to the NSW state average hospitalisation rates for respective conditions and have been reported in terms of being significantly higher or lower than NSW rates or NIL if there was no significant difference in compared rates. While the Shoalhaven area is identified as having the highest rate of coronary heart disease hospitalisations, for all other causes and for all causes overall, the Shellharbour area has the highest hospitalisation rates. Page 44

45 Table 47: Hospitalisations by causes, ISML areas, latest available years CAUSE OF HOSPITALISATIONS Diabetes hospitalisations Potentially preventable hospitalisations Smoking attributable hospitalisations Coronary heart disease hospitalisations All cause hospitalisations Alcohol attributable hospitalisations COPD hospitalisations INDICATORS AVAILABLE FOR to AREAS S. RATE/ 100,000 COMPARED TO NSW KIAMA Nil SHELLHARBOUR Higher SHOALHAVEN Higher WOLLONGONG 326 Higher KIAMA Nil SHELLHARBOUR Higher SHOALHAVEN 2979 Higher WOLLONGONG Higher KIAMA Lower SHELLHARBOUR Higher SHOALHAVEN Higher WOLLONGONG 699 Higher KIAMA Lower SHELLHARBOUR Higher SHOALHAVEN Higher WOLLONGONG Lower KIAMA Nil SHELLHARBOUR Higher SHOALHAVEN Higher WOLLONGONG Nil INDICATORS AVAILABLE ONLY FOR TO Fall related injury overnight stay hospitalisations High body mass attributable hospitalisations Source: NSW Ministry of Health Refer to KEY KIAMA Lower SHELLHARBOUR Higher SHOALHAVEN Nil WOLLONGONG Lower KIAMA Lower SHELLHARBOUR Higher SHOALHAVEN Lower WOLLONGONG Higher KIAMA Lower SHELLHARBOUR Nil SHOALHAVEN Lower WOLLONGONG Lower KIAMA Nil SHELLHARBOUR Higher SHOALHAVEN 764 Higher WOLLONGONG Higher Page 45

46 Hospitalisation for ambulatory care sensitive conditions (ACSC) Ambulatory care sensitive conditions (ACSC) are those for which, in theory, hospitalisation is thought to be avoidable through health care in ambulatory settings. Ambulatory settings are those outside the admitted hospital setting, for example, primary health care (including general practice), community care, emergency department care and outpatient care. Hospital admissions fall across a wide spectrum of preventability. The conditions selected for this measure are those thought to be sensitive to preventative care, adequate management of chronic conditions, and timely care for an acute illness in ambulatory settings, particularly primary health care 19. ACSC admissions are valid proxy indicators of access to primary health care. Socio-economic factors are most important in explaining variations in ACSC admissions 20. As shown in Table 47, compared to the NSW average, potentially avoidable hospitalisations (i.e for ambulatory care-sensitive conditions) are significantly higher among all the areas (LGAs) of the ISML catchment except for Kiama. Table 48 quantifies this comparison. The Smoothed Estimates of Standardised Separation Ratios (SESMR) across the ISML catchment indicate Shellharbour, Shoalhaven and Wollongong to be 45%, 14% and 12% higher than NSW hospitalisation SESMR for ambulatory care-sensitive conditions. Table 48: Hospitalisations for ambulatory care sensitive conditions (ACSC), ISML areas, AREAS S. Number of separations (no. per year) S. Ratio of standardised separations (estimate) Compared to NSW KIAMA Nil SHELLHARBOUR Higher SHOALHAVEN Higher WOLLONGONG Higher Source: NSW Ministry of Health Refer to KEY Emergency department (ED) admissions The major emergency department (ED) for the region is based at Wollongong hospital and has the highest role delineation of It receives presentations from the Illawarra population generally, and referrals from sister hospitals (Bulli, Shellharbour, Shoalhaven District Memorial and Milton-Ulladulla). The Wollongong Hospital Emergency Department (ED) is also the major paediatric emergency service for the Illawarra and Shoalhaven, and includes specialised services such as PEC (Psychiatric Emergency Care), ASET (Aged Services Emergency Team), and access to Short Stay Units such as MAU (Medical Assessment Unit) 29. While some health planners have stressed that emergency department activity for Triage 4 and 5 category presentations is closely representative of primary care patients, most empirical evidence has refuted the notion 30. However presentation trends of Triage 4 and Triage 5 categories have seen a decline in recent years for the Illawarra-Shoalhaven. Especially for the Triage 5 category presentations, the decline in relative numbers in Page 46

47 11 is very significant. Figures 13 & 14 show the number of presentations for Triage 4 and 5 categories for all the emergency departments within the Illawarra Shoalhaven Local Health District network of hospitals. Figures 13 & 14: Triage 4 presentation trends and Triage 5 presentation trends, ISLHD Source: AIHW 2012, MyHospitals data The proportional presentations for all the emergency departments within the Illawarra Shoalhaven Local Health District network of hospitals are shown in Figure 15. As a proportion of total presentations to an emergency department Bulli District hospital had the highest figures for the proportion of Triage 5 Category presentations calculated at 28%. For the Triage 4 Category, Shellharbour hospital had the highest proportional figures of presentations amongst all EDs in the ISML catchment with a calculated figure of close to 62%. Figure 15: Proportional ED Presentations by Hospitals, ISLHD, Source: AIHW 2012, MyHospitals data Page 47

48 5.3. Aged care Persons aged 65 years and above have been identified as a priority target group for the ISML health services planning. Services to this cohort of the population are focused on improving their quality of life and providing quality care and assistance for their disabilities. Figure 16 shows the 2011 disability prevalence for this cohort and their residential accommodation service utilisation. Figure 16: Proportions of persons aged 65 years and above who are: disabled and disabled residing in long term accommodation, ISML regions, 2011 Source: ABS Census 2011 and PHIDU Social Health Atlas of Australia: Medicare Locals, Published 2012 The ISML Catchment has 52 residential care services (low and high care) providing a total of 4,068 residential places within the ISML catchment. Table 49 shows the 2012 distribution of aged care service places within the regions of ISML. Table 49: Aged Care Places, ISML Regions, 2012 REGIONS High level Residential aged care places Low level Transitional care places Community care places KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment 1,931 2, ,249 Source: Department of Health & Ageing 2012 Page 48

49 As shown in Table 49, in addition to the high and low level care places, transitional care places are also available in some regions, aimed at improving a person s independence and confidence after a recent hospital stay. It gives the patients and their families some time to determine whether they could return home with additional support from community care services or need to consider placements in low or high level care facilities 23. Furthermore, community care services that enable persons to stay at home and reduce the ever increasing burden of residential care places are also widely available within the ISML catchment. The 2011 estimated population ratios of available aged care places for the population aged 70 years and above for all ISML regions is shown in Table 50. The ISML overall rate for high level care places is significantly low as compared to NSW state and Australian national rates with Shoalhaven Balance region having the lowest rate. Population rates for other service places and for the total residential care places indicate a considerable need for more places in the Shellharbour region. Table 50: Population ratios of aged care places, ISML regions, 2011 Places per 1000 persons aged 70 years and over for: REGIONS Residential aged care places High level Low level Total Community care places KIAMA SHELLHARBOUR NOWRA-BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: Department of Health & Ageing Special programs and target groups The Commonwealth Government Department of Health and Ageing (DoHA) has put special programs in place, figures of which are excellent indicators of primary care service utilisation. These programs are intended to focus on either the special needs of target groups such as the ageing population or to address the risk of conditions that have been identified as burgeoning public health burdens such as mental health Commonwealth Home and Community Care (HACC) program HACC (Home and Community Care) is a Commonwealth funded program providing basic maintenance and support services to help frail older people (65 and over and 50 and over for Aboriginal and Torres Strait Islander people) and people with disabilities of all ages to Page 49

50 continue to live in the community 24. It is primarily aimed at persons who are at risk of premature or inappropriate admission to long term residential care and is also available to the carers of older Australians eligible for services under the Commonwealth HACC Program 24. Table 51 shows the rates of service instances of the various services provided under the HACC program for the ISML catchment in Overall there is a lower service uptake rate in the Wollongong area with both the Wollongong Inner and the Wollongong Balance regions having the two lowest rates of total instances of assistance amongst all regions of the ISML catchment. Table 51: Home & Community Care program: service instances, ISML regions, HACC INSTANCES (ASR per 1000) JBT Kiama Shellhar Shoal Pt-A Shoal Pt-B Wollong Inner Wollong Balance ISML NSW AUS Allied health care instances at home Allied health care instances at centre Care counselling instances Case management instances Centre based day care instances Client care coordination instances Domestic assistance instances Home maintenance and modification instances Meals at centre plus meals at home instances Nursing care at centre plus nursing care at home instances Personal care instances Respite care instances Social support instances Transport instances TOTAL INSTANCES OF ASSISTANCE NA NA NA NA NA NA NA Source: PHIDU Social Health Atlas of Australia: Medicare Locals, Published Refer to KEY The client profile for the HACC services in the ISML catchment is shown in Table 52. The ISML catchment has a very low percentage of HACC clients with carers estimated at just 17.4% compared to the significantly higher percentage figures for both the NSW state and Page 50

51 Australian national figures. The very high percentage of Indigenous clients in the Nowra- Bomaderry region and the significantly high percentage of non-english speaking clients in the Wollongong Balance region are an indication of the vulnerability of these target groups and hence are a prime focus of the ISML Population Health and Primary Health planning. Table 52: Home and Community Care program: client profile, ISML regions, REGIONS Clients living alone (%) Clients with carer (%) Indigenous clients (% total clients) Indigenous clients (% Indigenous population) Non-English speaking clients (%) TOTAL NUMBER OF CLIENTS JERVIS BAY KIAMA NA NA SHELLHARBOUR ,503 NOWRA- BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance , , , ,550 ISML Catchment ,106 New South Wales ,087 Australia ,561 Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published Better Access program The Better Access program is a Federal Government initiative that aims to improve treatment and management of mental illness within the community through making MBS rebates available for selected mental health services provided by GPs, psychiatrists, psychologists, eligible social workers and occupational therapists. The MBS items and new referral pathways to clinical psychologists and other allied mental health service providers will help GPs and psychiatrists to provide more and better targeted mental health care for patients. The program complements the range of initiatives funded under the Better Outcomes in Mental Health Care program (BOIMHC) and its components, in particular the Access to Allied Psychological Services (ATAPS) component which is directly managed by Medicare Locals 25. Table 53 shows the standardised rates of MBS item utilisations under the Better Access program for for all regions of the ISML catchment. The low uptake of the psychiatry component of this program in the Shoalhaven Balance region is a reflection of the limited availability of psychiatrists in this region. However, as indicated earlier, further analysis is needed to determine whether these rates are driven by demand and/or supply. The Shoalhaven Balance region is also found to have the lowest uptake rates for all of the allied Page 51

52 health services, namely the psychologist, social worker and occupational therapist service components of the Better Access program. Table 53: Better Access program: service Utilisation, ISML regions, REGIONS Preparation of Mental Health Care Plan by GPs (ASR per 1000) Psychiatrists (ASR per,000) Psychologists (ASR per 1000) Social workers (ASR per 1000) Occupational therapists (ASR per 1000) KIAMA SHELLHARBOUR NOWRA- BOMADERRY SHOALHAVEN Balance WOLLONGONG Inner WOLLONGONG Balance ISML Catchment New South Wales Australia Source: PHIDU Social Health Atlas of Australia: Medicare Locals, published Refer to KEY Key Indigenous health findings Australian Indigenous populations have consistently been reported to have significantly poorer health status and outcomes when compared to non-indigenous persons. The same is also evident within the ISML catchment. While several Indigenous health indicators are only reported at the NSW state or Australian national level, selective data analysis undertaken at the Medicare Local level reveals some significant findings for the Indigenous population of the ISML catchment. These findings are: For the majority of causes of hospitalisations recorded in , the Indigenous rates per 100,000 population exceed the rates of hospitalisation for non-indigenous persons within the ISML catchment. Compared to non-indigenous populations, the Indigenous population of the Illawarra- Shoalhaven had more than double the crude hospitalisation rates in for causes such as: factors influencing health: dialysis; alcohol attributable hospitalisations; smoking attributable hospitalisations; endocrine diseases; mental and behavioural disorders; blood and immune system diseases; Page 52

53 respiratory diseases; and potentially preventable hospitalisations. Other vital causes of hospitalisations in such as injury and poisoning, maternal and neonatal causes, cardiovascular diseases and infectious and parasitic diseases also accounted for 1.4 to 1.9 times higher rates within Indigenous populations compared to non-indigenous. Maternal health indicators for recent years reveal a mixed picture. The data on the percentage of low birth weight babies as recorded in reveals figures of 9.1% for Indigenous residents of the ISML catchment compared to 5.7% for non-indigenous. Similar figures for pre-term births were reported to be 9.9% and 7.9% respectively for Indigenous and non-indigenous mothers of the ISML catchment in However in terms of early access to antenatal care, the Indigenous population within the ISML catchment is reported to have better figures than both the non-indigenous population of the ISML catchment as well as a higher than NSW state average figure for all populations. 84% of Indigenous women in the ISML catchment were reported to undertake their first antenatal care visit within the first 14 weeks of pregnancy in 2010, compared to 82.6% for non- Indigenous persons and 79.1% for the NSW state average for all populations. All the health service indicators identified in this section of this Population Health Profile: 2013, will be regularly monitored by the ISML Population Health planning processes, and will be carefully examined to identify essential service gaps in all the primary health and ageing services delivered across the Illawarra-Shoalhaven. Within the acute care sector, the ISML population health planning processes will aim to work with the Illawarra-Shoalhaven Local Health District to reduce preventable hospitalisations and avoidable emergency presentations as identified in this section of the report. Strong focus will be given to multiagency programs such as the Better Access program and the Home and Community Care program amongst several other similar initiatives, so as to foster a collaborated and shared care model of healthcare delivery across all providers and agencies. Holistic service delivery to the Indigenous community will be one of the key priorities of all ISML Population Health endeavours so as to address the wide disparity that exists in the demographic and health status indicators for Indigenous persons as identified above as well as before in this report. Page 53

54 6. PRIMARY HEALTH WORKFORCE CAPACITY Both general practice and allied health workforce are believed to be the most significant providers of primary health care services in the ISML catchment General practice The Australian Government Department of Health and Ageing releases general practice workforce statistics for Medicare Locals (former Divisions of General Practice) which are based on the claims processed by the Department of Human Services. Table 54 shows the summary of general practitioner (GP) workforce statistics for the financial year. Table 54: Summary of general practice workforce statistics, ISML, INDICATOR Male Female Total GP headcount Total services claimed 1,774, ,881 2,489,967 Source: DoHA, 2013, Medicare Local Statistics and Data The ISML catchment has been consistently served by a higher proportion of male GPs as compared to female GPs. However, age trends indicate that the proportion of younger aged GPs has been steadily increasing since The proportion of GPs aged less than 35 years has risen by 67.6% in the two years since Figures 17 & 18 show the gender and age split proportions based on headcounts of general practitioners in the ISML catchment for the financial year. Figure 17 & 18: GP gender proportions and GP age proportions, ISML, Source: DoHA, 2013, Medicare Local Statistics and Data Access to reliable, comprehensive, timely and nationally consistent trend data is required to understand the current health workforce and for workforce planning 27. ISML conducts regular Page 54

55 workforce audits to gain an accurate picture of the local general practice workforce. The recently conducted Workforce Audit 2012 was undertaken in the latter half of 2012 by ISML s Primary Care Support team. It was conducted in two legs, one each for the Illawarra and the Shoalhaven. Out of the 115 operational practices (as of the fourth quarter of 2012) in the ISML catchment, 107 practices participated in the audit resulting in a response rate of 93%. Responses from these 107 practices were collated and analysed by ISML s Population Health Stream. 47.7% of the practices had three or more GPs working on-site. This was higher than the proportion of solo GP practices in the region which was calculated to be 31.8%. Figure 19 shows the overall distribution of practices in the ISML catchment. Figure 19: Distribution of general practices, ISML regions, 2012 Source: ISML 2012 Workforce Audit Report, 2013 The total number of general practitioners (GPs) has risen consistently ever since 2009 with the Illawarra region seeing a growth of 10% in the number of GPs in the three years. However, full-time work has decreased and part-time practice is becoming more common. The 2012 audit found more than twice as many part-time practitioners as full-time. While the overall ISML catchment figure of full-time GPs was just 32%, it was the least for the Kiama region with no (0%) identified full-time GPs in the region. The overall GP service distributions are shown in Figure 20. Figure 20: GP distribution*, ISML regions, 2012 * Points of Service Counts have been used and not Headcounts. Source: ISML 2012 Workforce Audit Report, 2013 Page 55

56 The DoHA, NSW Health and AIHW recommended standards of workforce capacity reporting utilise full-time equivalents (FTE) rates that cap hours worked to a standard of 40 hours per week as a full-time figure 27. These standards have been used to calculate general practitioner (GP) FTE rates per 100,000 population. In 2012, there were 262 FTE in the Illawarra-Shoalhaven equivalent to a rate of 68.1 FTE per 100,000 population in the ISML catchment. This is lower than both the NSW state figure of 81.3 FTE per 100,000 and the Australian national figure of 78.9 FTE per 100,000 for FTE figures for individual regions within the ISML catchment are shown in Figure 21. Figure 21: Estimates of GP full-time equivalents (FTE) rates per 100,000 population^, ISML regions, 2012 Statistical extrapolation based on ERP 2011 and hours of work adjustments. Non-participation in the ISML 2012 Workforce Audit by a few practices may have diminished the accuracy of FTE calculations and hence it is advisable to best use these figures as close estimates only. Source: ISML 2012 Workforce Audit Report, The ISML has an ageing GP workforce with more than half (50.2%) the general practitioners aged above 50 years. Figure 22 shows the distribution of ages for all GPs in the ISML catchment. Figure 22: Age distribution of general practitioners, ISML, 2012 Source: ISML 2012 Workforce Audit Report, 2013 Page 56

57 As shown in Figure 23, a relatively high proportion of practices in the ISML catchment have practice nurses employed on site with an overall ISML figure of 64.5% of all practices. While all of the Kiama practices employed practice nurses, amongst the other regions the Nowra- Bomaderry region had the highest proportion of practices having practice nurses. Figure 23: Proportions of practices employing practice nurses, ISML regions, 2012 Source: ISML 2012 Workforce Audit Report, Allied health The Illawarra-Shoalhaven Medicare Local has recently begun active processes targeted at support and engagement for allied health professionals and is undertaking a review of the available allied health services within the catchment. A presently non-comprehensive evidence base of the available allied health services within the ISML catchment warrants the need for improving data collection arrangements for accurate service mapping and gaps analysis. A secondary analysis of the available information on the number of major allied health professionals within the ISML catchment is shown in Figure 24. Figure 24: Proportions of allied health professionals*, ISML, 2013 * Allied health professionals and services accounting for less than 2% have not been included in the analysis due to unreliable data. Data accuracy is currently being reviewed and updated. Source: ISML Database: Division Information System (DIS), 2013 maintained and updated by ISML Primary Care Support team. Page 57